In short: children’s feet are still forming, so flat arches and a slightly turned-in walk are often normal stages rather than problems. What does warrant an assessment is pain, limping, a child pulling out of activity, one foot behaving differently from the other, frequent tripping or uneven shoe wear. Both Gideon Poratt and Bryce Foothead treat children across our four Melbourne clinics, and no referral is needed.
How children’s feet differ
A child’s foot is not a small adult foot. Much of it is still cartilage that has not yet turned to bone, the joints are more mobile, and the muscles that hold the arch are still building strength through everyday walking and running. That flexibility means growing feet adapt to activity far better than adult feet do.
It also means the same finding can mean different things at different ages. A very mobile flat foot in a four year old is expected; the same foot in a sore fourteen year old is worth looking at properly. During growth spurts, bones lengthen before the muscles and tendons attached to them catch up, so things get tight and load concentrates at the growth plates. That explains a lot of childhood foot and heel pain, and why it tends to settle once growth slows.
What is normal as feet develop
Young children almost all look flat footed. There is a pad of fat under the arch, the ligaments are loose, and the arch has not developed yet. In most children it appears gradually and is visible by around age six to eight, often earlier when the child stands on tiptoes.
Toddlers also walk with a wide base and heavy footfalls, and many turn their feet in or out. Legs change alignment through childhood as part of normal growth, so the walking pattern at three is often not the pattern at eight.
When to have your child checked
Normal stages do not usually stop a child doing what they want to do. Book an assessment if you notice any of these.
- Pain in the foot, heel, ankle, knee or leg that persists or is still there the next morning. Most children under-report foot pain rather than exaggerate it.
- Limping that lasts more than a day or two.
- Avoiding activity. A child who sits out sport, asks to be carried or stops keeping up with friends is often sore.
- One side different from the other in shape, position or comfort. A difference between feet matters more than the same finding on both.
- Frequent tripping beyond what you would expect for the age, or tripping that is getting worse.
- Uneven shoe wear, or one shoe breaking down far faster than its pair.
- A skin or nail change that is not settling, including a painful lump on the sole.
Problems we commonly treat
Severs disease (calcaneal apophysitis)
The most common cause of heel pain in active children, typically between about eight and fourteen. Load through the growth plate at the back of the heel makes it sore during and after sport, often worse on hard surfaces or in flat, worn footwear. It settles with time, but children do not have to put up with it meanwhile. See our heel pain page.
Growing pains
Deep aching in the calves, shins or thighs, usually in the evening, usually on both sides, and gone by morning. Genuine growing pains do not cause limping or one-sided pain. When the pattern does not fit, we look for another cause such as shin splints or a stress reaction.
In-toeing, out-toeing and flat feet
Usually structural and usually changing with growth. We measure where the rotation comes from, whether it is symmetrical, and whether it is actually causing symptoms. When a child is sore or tiring quickly, footwear changes, strengthening and sometimes orthotic therapy reduce the load while growth does its work.
Plantar warts
Very common in school-aged children and picked up through pools, gyms and shared bathrooms. Our clinics use a GenesisPlus Nd:YAG 1064nm laser — needle-free, though the pulses do sting, so it suits teenagers and older children best and we assess each child before recommending it. Most patients see results in two to four sessions. More on laser wart removal.
Ingrown toenails and blisters
Ingrown nails become common in the teenage years and respond well to early treatment. Blisters from new school shoes and football boots are worth solving properly rather than taping over each week, and our blister page covers the fixes.
School shoes and sports shoes
Children spend more hours in school shoes than in anything else they own, so fit is worth getting right.
- Fit both feet late in the day, standing, in the school sock. Feet are bigger by the afternoon and one foot is usually longer.
- Leave about a thumb’s width past the longest toe, with enough width that the toes are not pressed together.
- The shoe should bend at the ball of the foot and should not twist easily through the middle.
- Look for a firm heel counter you cannot squash flat, and a fastening that holds the foot back into the heel.
- Check the fit again each term. Growth does not wait for the sales.
Bryce also manages a technical footwear store, so advice here goes beyond general rules to specific models and fitting problems, including boots for football, netball and athletics. For more, read choosing school shoes, and for young athletes see sports podiatry.
What the appointment is like
Nervous children are normal and we plan for it. Nothing happens without your child knowing what it is, we show instruments before using them, and most paediatric appointments involve no sharp instruments at all. We talk to the child as well as the parent, watch them walk and run, check joint movement, strength and skin, and look at the shoes you bring in.
You leave with a plain explanation of what we found and whether it needs treating now. No referral is needed unless you hold a DVA Gold Card or are claiming through WorkCover. Health fund rebates can be claimed on the spot through HICAPS at every clinic, and we accept Visa, Mastercard and EFTPOS.
Common questions
At what age should a child first see a podiatrist?
There is no minimum age. We see children as soon as there is something to look at: pain, a limp, an unusual walking pattern, or a parent who simply wants a check. Many families book a first visit around the start of school, when footwear and activity both step up.
My child has flat feet. Do they need orthotics?
Usually not. A flexible flat foot in a young child with no pain generally needs nothing but sensible shoes. We consider orthotic therapy when a child is symptomatic, tires quickly, or has a foot position that is not improving with growth. Our do I need orthotics article explains how that call is made.
Are growing pains real?
Aching legs during growth are real and common: evening onset, both sides, settled by morning. What they should not do is cause a limp, stay one-sided, or persist through the day. When the pattern does not fit that picture, it is worth assessing rather than assuming.
Will my child grow out of it?
Many things do resolve with growth, and we will say so when that is the likely outcome. Pain is the exception worth acting on, because a child who is sore now will avoid activity now, and reducing the load is usually straightforward.
Is laser treatment suitable for warts in children?
Sometimes. The laser is needle-free, but each pulse does sting — a sharp pin-prick — and younger children may not tolerate it. We assess each child first and will tell you honestly if a simpler approach makes more sense. Where laser is the right fit, most patients see results in two to four sessions.
Which clinic should we come to?
Whichever is easiest for you: Burwood East, Clayton, St Helena or Windsor. Addresses, opening hours and phone numbers for all four are on our locations page.
This page is general information, not personal medical advice. Reviewed by Gideon Poratt, Principal Podiatrist (B.App.Sc (Pod), M.A.Pod.A), a member of the Australian Podiatry Association. Please book an assessment for advice specific to your feet.